10 region. However, under certain circumstances, a operating tool, if any. 1

,45 my invention, a sheath is employed having a Patented June 21,1938 I i a j l v j g U 7 2,120,996 orsroso'orrc, Frederick Charles Wappler, New York, N.Y. 7 Application October; 9, 1936,?SerialN0. 104,76? .11 Claims. (01. 1 2847 My present invention relates generally to surthereby permitting the lamp toproject fromthe gical instruments, and has particular reference to 'forward end of thesheath in av laterally ofiset an improved cystos'copic armamentarium. position. v r g In the examination and treatment of inte- The'plug of the lamp carrier is further pro- ,5 ,rior portions of the human body, differing condivided with an axial bore adapted to accommodate tions require instrumentsof difiering capabilia telescope therethrough; and the sheath has a ties. All modern instruments of the cystoscopic lumen. just sufficient to accommodate the televariety embody a means for illumination, and a scope and the stem, combined, or just suflicient to telescopic 'means for viewing ,the illuminated accommodate the telescope, the stem, and an- H 10 directly forward visibility is called for; under The structural improvements referred to per-' 3 other conditions a view in a forwardly oblique mit the production of a'highly efficient armamendirection is preferable; and in many instances a tarium consistingessentially of a series of sheathspurely lateral, or even a retrograde, field of vision having differing cross-sections, but having sever- .15 is required. In-order that the desiredfield be al features in commonya series of telescopes havadequately illuminated to a maximum extent, ing dififering objectives, but of common cross-- it is usually necessary to provide different arsection; and a single lamp carrier of novelchar- 'rangements for mounting the lamp. Furtheracter capable of interchangeable and-selective em more, depending upon whetherthe instrument is ployment with any chosen sheath and any chosen to be used for purely diagnostic purposes or for telescope. v I g I 20' differing types of treatment, sheaths of different I achieve the-foregoing objects, and such other characteristics and capabilities, are called for. objects as may hereinafter appear or be pointed In view of the foregoing, a surgeon desiring to out, in. the manner illustrativ ely exemplified in 'be fully equipped with instrumentalities of max the accompanying drawing,v whereinimum efiiciency is called upon to have available a I Figure 1 is a perspective view of an assembled 25 considerable quantity of equipment. I .cystoscopic'instrument constructed in accord- A general object of my present invention is to ance with my present invention; g provide improvements in cystoscopic instruments, Figure 2 is a side view of the lampcarrierby whereby a minimum number of selectively interitself; 7 I I e 3 O changeable elements may be made to constitute Figure 3 is aside view of the sheath of Figure an armamentarium having a large variety of dif- 1 by itself; a l M fering capabilities. Thus, an armamentarium of Figure lis a side view of the telescope of Figthe present character furnishes, at relatively reure 1 by itself; -duced expense, the equivalent of a far more ex- Figure 5 is a perspective View of the forward 'tensive array of conventional .instruments, enend of a modified. cystoscopic instrumentca- 35 abling an operator under all circumstances,and pable of assembly by the elements of the present without the necessity for a large array of equip- .armamentarium;

' ment, to employ an assembled instrument of min- Figure 6 is a cross-sectional view showing the imum calibre having exactly the capabilities and possibility of using a telescope of one type; v 40 qualities that may be called for. Figure 7 is a view similarto Figure 6, showing 40 The successful production of the present imthe possibility of, using atelescope of another proved armamentarium is predicated upon a type; 1 novel mode of separable assembly, of sheath, Figure 81s a view similar to Figure 6,-showing telescope, and lamp carrier. In accordance with .the possibility of using a telescope of a third type; I

vFigure .9 is a cross-sectional view taken .subrear socket and an open front or distal end; and. stantially along the line 9--9 of Figurel; a lamp carrier is used which comprises a plug Figure 10'is a cross-sectional view taken sub-' cooperable with the sheath socket, an extremely stantially along the line l0,|ll of Figure 5; thin stem projecting fromthe plug, and a lamp Figure llis across-sectional View similanto larger than the stem and mounted 'on its for- Figures 9 and 10,'showing the possibility of using 50 ward end. The stem has a length at least as a different sheath; and great as the rear wall of the sheath, and the stem Figure 12 is a r ssectional View similar to is eccentricallymounted with respect to the plug, Figure 9, showingthe possibility of using. another so that when the parts are assembled the stem lies type of sheath. H I I J 1 .,5 closely alongside of the rearwall of the sheath, In Figure 1 I-haveshown the general type 01 crystoscopic instrument to which my invention relates.' A sheath 29 is provided at its rear or proximal end with a socket 2 I. Depending upon the purposes for which the sheath is intended,

-'- equivalent.

an irrigation petcock 22 may be provided, and I have illustratively shown only one such petcock. I have also shown a sheath having a rear inlet end 23 for a tool such as the catheter 24. Assembled with the sheath in a manner presently to berdescribed in. greater detail is a lamp carrier having a rear plug 25 and carrying an electric terminal 26, and a telescope of whic the ocular 27 is shown in Figure 1.

The exact nature of the instrument of Figure. 1, and the general nature of the invention as a Whole, will best be appreciated by referring to Figures 2, 3, and 4. In Figure. 31 have shown the sheath 20 by itself. This particular sheath has a cross-sectional configuration of-somewhat elliptical character, as shown in Figure 9. It has an open front end 28 and a transverse deflector ban-29 positioned -a small distance in advance of the front end 28. For a purpose presently to -be described, the socket 2| has a notch i3ll,or its The telescope'shown in Figure l-has the cylinidrical body portion or barrel 3-'I'and is provide'd with an objective at its forward end. The particular telescope shown in Figures-l and 4 (and also in Figure 6) commands a forwardly oblique field of vision substantially defined by the-dotand-dash lines 32. I Y

' The lamp carrier, shownmost clearly in Fig-- ure 2, has an axial bore 33 extending through the plug '25. It will be observed that the plug-has a forward portion of somewhat reduced diameter. It is this portion which is adapted to fit snugly into" the socket 2| of the sheath. To insure a proper positioning of the plug, it carries a projection 34, or its equivalent, adaptedto cooperate and interengage with the notch 30 in the sheath socket. I

Extending forwardly from the plug 2 5, and, more particularly, from a point directly alongsideof the bore 33, is a stem 35 and mounted on the forward end of the 'stem', preferably-in the offset relationship shown, is the lamp socket 36 and the miniature electric lamp 31, An insulated electric conductor, indicatedby the dottedline 38, extends through the stem 35 'frornthe terminal 25 to thelamp 31. The details of the electrical connections have not been shownjbecause these are known per sein-thart. I wish to point out, however, that the stem 35is'pu-r posely of a size which is just large enough to accommodate the insulated conductor 38. One method of forming the stem is to employ an extremely fine pieceof tubing, suchas that which enters into the manufacture of hypodermic needles. 3 v

' The stem 35 is purposely of a length which is at least .as great .as 'the length of the rear wall of the sheath. By the term rear wallf I intend to refer to the wall which is uppermost in Figure '3, i. e., furthest removed from the field of visionor area of operation; .'Ihel'sheat h of Figures fl and 3 is intended to be used with a single small-sized catheter 24, and reference to Figure 9 will make it apparent that the sheath has .a lumen, i. e., an internal shape and capacity, just sufficient snugly to ac- .commodate the telescope 3 I, the stem '35, and the catheter ortoo124. It'i's'further to be no ed. manding a forwardly Oblique fieldfif Vision,

that the lamp (by which term I refer to the parts 36 and 3l'collectively) has a calibre, i. e., an exterior shape and girth, which is no larger than that of the telescope.

The reasons for the various specific relationships of sizes, as hereinbefore described, will be more fully appreciated by describing the manner in which the instrument of Figure 1 is assembled.

The lamp carrier of Figure 2 is first inserted into the sheath of Figure'B. During the process of insertion, the bore 33'will be out of alignment with the axis of the sheath, because of the eccentric arrangement of the stem 35 and the lamp.

inserted into the socket and interengaged there- 'with by means of the cooperable parts 3!] and 34. This preliminary assembly having been effected, the stem 35 will lie closely adjacent to the rear wall of the sheath (see Figure '9), and the lamp will project forwardly "from. the sheath in a laterally offset position, asj shown most clearly in Figure 1. The final stepin the assembly is to insert the telescope of Figure 4. "This telescope will pass through the bore 33, and will then pass axially through the sheath and will project at the forward end, as shown in Figure 1. "The subsequent insertion and use ofthe catheter 24 will be obvious to those skilled in'the art. The forward end of the catheter will pass under 'the'bar 2'9 and will thus be directed into the illuminated field of vision.

' The particular instrument illustrated in Figure 1, and heretofore described, thus constitutes a crystoscope which commands a forwardly oblique-field of vision, and which is equipped for theemployment of a single small-sized catheter. In the event that the operator desires merely a diagnostic instrument, 1. e, one which is used solely for inspection purposes, he would choose from the armamentarium a sheath 38] shown in Figures 5 and 10. This sheath has a sort'or oval .or egg-shaped cross-section, having :a lumen just 'sufficient to accommodate the telescope 39 and the lamp carrier stem 35; The resultant instrument, when assembled in the manner here- 'inbefore described, will have a forward end as 'shownin Figure '5. The advantage of this recapable of passing a larger catheter, or possibly an electrode or the like, he will choose from the armamentarium a sheath 43 (Figure 12*) having a lumen just sufficient to accommodate the telescope the lamp carrier stem 35, and thetool 45.

The operator also has available besides the telescope shown in Figures 4 and 6 and comtelescope 46, shown in Figure 7, commanding a directly forward field of vision indicated at 41, and a telescope 48, shown in Figure 8, commandinga purely lateral field of vision indicated by the lines 49. Telescopes having other objective capabilities may also be available.

In each of Figures 6, 7, and8 I have, for illustrative purposes, shown a sheath which is identical with the sheath of Figure and for this reason I have designated the sheath of Figures 6-8 withthe reference numeral 38. It will beunderstood, however, that any selected sheath may be employed.

Also, it will be understood that the telescopes designated 3|, 39, 4|, and 44 in Figures 9-12 may be of any selected type, as illustrated in Figures 6-8.

It should be noted that the telescope 48 has a somewhat shorter length than the other telescopes. This avoids the production of a shadow in the lateral field of vision.

Summarizing, the present improved armaa series of sheaths (illustratively designated 2!], 38, 40, and 43), a series of telescopes (illustratively designated 3!, 46, and 48), and a lamp carrier of the improved character illustrated in Figure 2. The sheaths, while differing in lumen, have in common the fact that they all have rear walls of equal lengths, and end sockets of standardized character. The telescopes, while differing in objectives, and possibly differing slightly in lengths, have in common the fact that they are all of uniform cross-section, permitting them to be interchangeably inserted through the bore 33. The improved lamp carrier is a single element common to all of the various instruments that may be assembled. The catheters or equivalent tools are well known per se and readily available to any surgeon, and are referred to in the appended claims by the generic term tool.

An outstanding advantage of the present invention lies in the fact that any instrument which is assembled has a calibre of the smallest possible character. The extra space which is taken up by the lamp is at the extreme tip of the instrument, where the added size is unobjectionable, because of the fact that this end of the instrument is disposed within the body cavity, e. g., the bladder. The separable nature of the instrument permits the insertion and removal of the same without requiring that the relatively large forward end of the instrument be inserted or withdrawn, with accompanying pain, irritation, and possible injury, through the extremely constricted passage leading to the bladder or other interior cavity.

I deem it to be within the purview of my invention to modify the stem of the lamp carrier by constructing its rear end in the form of a tube concentrically arranged with respect to the bore 33. Such a construction may, under certain circumstances, be desirable for the purpose of imparting added strength to the stem. Where such a construction is used, the total length of the stem must be correspondingly increased to permit the parts to be brought into axial relationship in completing the assembly of any desired instrument.

Those skilled in the art will appreciate, of course, that the-cross-sectional views shown in the accompanying drawing are necessarily exaggerated with respect to the relative thickness of the sheath material, of the lamp carrier stem, etc.

In general, it'will be understood that changes in the details, hereindescribed and illustrated for the purpose of explaining the nature of my invention, may be made by those skilled in the art without departing from the spirit and scope of the invention as expressed in the appended claims. It is, therefore, intended that these details be interpreted as illustrative, and not in a limiting sense.

Having thus described myinvention, and illustratedits use, what I claim as new and desire to secure by Letters Patent is 1. A cystoscopic instrument comprising a sep arable assembly of a sheath, a telescope, and a lamp carrier; said lamp carrier comprising a thin stem at least as long as the rear wall of the sheath, and a lamp mounted on its forward end; said sheath having a lumen just sufficient to accommodate said telescope and said stem and said lamp having a calibre no greater than that of said telescope.

2. A cystoscopic instrument comprising a separable assembly of a sheath, a telescope, a lamp carrier, and a tool; said lamp carrier comprising a thin stem at least as long as the rear wall of the sheath, and a lamp mounted on its forward end; said sheath having a lumen just sufiicient to accommodate said telescope, stem, and tool; and said lamp having a calibre no greater than that of the telescope.

3. A cystoscopic instrument comprising the elements set forth in claim 1, in combination with an electric terminal on the rear end of the lamp carrier, an insulated electric conductor extending through said stem from the terminal to the lamp, and said stem being just large enough in crosssection to accommodate said insulated conductor.

4. A cystoscopic instrument comprising the elements set forth in claim 2, in combination with an electric terminal on the rear end of the lamp carrier, an insulated electric conductor extending through said stem from the terminal to the lamp, and said stem being just large enough in crosssectionto accommodate .said insulated conductor.

5. In a cystoscopic instrument, the combination with a sheath having an open distal end and a socket at its proximal end, of a lamp carrier comprising a plug cooperable with said socket, an eccentric stem extending from said plug and having a length at least as great as the rear wall of the sheath, and a lamp mounted on the forward end of said stem, saidstem being offset from the plug axis so as to lie directly alongside of said rear wall when the parts are in assembled relation, whereby the lamp will project from the sheath in a laterally offset position.

6. In a cystoscopic instrument, the combination set forth in claim 5, said plug having an axial bore adapted to accommodate a telescope therethrough.

7. In a cystoscopic instrument, the combination with the elements set forth in claim 5-, of a telescope extending axially through said plug and snugly accommodated in said sheath alongside of said stem.

8. As an element of a cystoscopic instrument, a lamp carrier comprising a bored plug adapted to enter a sheath socket and to accommodate a telescope in said bore, a stem extending from a point on said plug directly alongside of said bore, and a lamp mounted on the forward end of said stem.

9. As an element of a cystoscopic instrument, a lamp carrier comprising a bored plug adapted to enter a sheath socket and to accommodate a telescope in said bore, a stem extending from a point on said plug directly alongside of said bore, a lamp mounted on the forward end of said stem, an electric terminal on said plug, and an insulated electric conductor extendng through said stem from said terminal to said lamp.

10. As an element of a cystoscopic instrument, a lamp carrier comprising a bored plug adapted to enter a sheath socket and to accommodate a telescope in said bore, a stem extending from a point on said plug directly alongside of said bore, a lamp mounted on the forward end of said stem,